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Dialysis patients who are black, smoke, or use illicit drugs are more likely to skip treatments

Hemodialysis patients who are black, smoke, or use illicit drugs are more likely than other patients to skip dialysis treatments than others. Skipped treatments and poor dietary adherence are strongly associated with greater risk of death among end-stage renal disease (ESRD) patients. Understanding why high-risk patients do not adhere to treatment and providing interventions could prevent their premature death, advise the researchers of a study supported in part by the Agency for Healthcare Research and Quality (HS08365). The researchers examined predictors of hemodialysis skipping and serum potassium and phosphate levels (indicative of dietary adherence) with survival using data from the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.

Among 739 dialysis patients with ESRD, a total of 67 patients were classified as skippers, because they missed more than 3 percent of scheduled dialysis treatments. Patients who were black were more than twice as likely to skip treatments, current smokers were nearly twice as likely to do so, and users of illicit drugs (marijuana, cocaine, and heroin) were nearly 4 times as likely to skip treatments. Skipping was associated with a 69 percent greater risk of death. Also, a phosphate level greater than 5.5 mg/dL and potassium level greater than 5.0 mEq/L (markers of poor dietary adherence) were associated with a 59 percent and 50 percent greater risk of death, respectively.

The majority of study participants missed none of their treatments, whereas 9.1 percent missed more than 3 percent of them. During an average followup of 938 days, 316 of 739 hemodialysis patients died.

More details are in "Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients," by Mark L. Unruh, M.D., Idris V. Evans, M.S., Nancy E. Fink, M.P.H., and others, in the December 2005 American Journal of Kidney Diseases 46(6), pp. 1107-1116.

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